Third trimester uterine torsion: case report

Rotation of the gravid uterus is a normal finding in the third trimester of pregnancy. However, a pathologic rotation of the uterus beyond 45 degrees-torsion of the entire uterus-is rarely seen in obstetrical practice. We report here a case of uterine torsion from our obstetrical practice and a review of reported cases.

The patient, a 36-year-old gravida 3 para 2 at 36 weeks' gestation with a singleton pregnancy, was admitted to the obstetrical unit with uterine cramping and decreased fetal movement. Her prior obstetrical history included two uncomplicated term vaginal deliveries, and the current pregnancy had been uncomplicated until the date of presentation. After 3 hours' observation, uterine cramping and tenderness increased, and fetal tachycardia developed. The presumptive diagnosis was a concealed placental abruption. The patient was not in labour, so an emergency Caesarean section (CS) was carried out. At the time of CS, the diagnosis of uterine torsion was made. The patient recovered and was discharged home with her baby on the third postoperative day.

Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences.